03-105507 J f
City of Federal Way
Community Development Services Electrical Permit #:03 - 105507 - 00 - EL
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253 661 4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: CHECKMATE
Project Address: 28722 PACIFIC S Parcel Number: 332204 9119
Project Description: Move circuit and J-box serving relocated,illuminated monument sign.
Owner Applicant Contractor
CAPITAL RESOURCE GROUP LL CHECKMATE FULLER ELECTRIC
28722 PACIFIC HWY S 34918 ENCHANTED PKWY S A-1&2 FULLER ELECTRIC
FEDERAL WAY WA 37107 12TH AVE S
98003-3224 \FEDERAL WAY WA 98003 (253)661-7181
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits- Commercial 1
PERMIT EXPIRES June 19,2004.
Permit issued on
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agen T . DAiLriV Date: 2 -2 2 0)
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• RECEIVED '
CONSTRUCTION PERMIT APPLICATION
CITY of 40111.1111\r" DEC 2 2 200,3 APPLICATION NUMBER: Q3- 1 05;502- (DO
Federal vvay APPLICATION DUMBER _ _ _ -
CITY OF FEDERAL WAY APPallBEI �
BUILDING DEPT. - -- - -
**The following is required information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
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• PROPERTY INFORMATION
SITE ADDRESS: R 7'L2- r c . C Nc 1 .. ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Ch L-k
• PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL ❑DEMOLITION
FCTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
rnev2 C..; 5f, h 9 S, Lt, L 0 ve. G•0r et./ c.,1
PROJECT NAME: CAA e ik PA 44 e
• PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
CIN
MAILING ADDRESS(STREET ADDRESS;QTY,STATE,ZIP):
7)" pati -E. 14,.} Y sc
CONTRACTOR: NAME: DAYTIME PHONE:
r'lrf /e Jr, (.4.s3 ) 66/ -7/(F/
• MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHON :
37/b ? l.Z P ve_ SC bLiay Lc//9 ;ce.k: ( 2.53 ) 66 / - //E/
QTY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
23 - J ' 3 . 6V - o ( 2s3 ) G6/ -62.56
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) L u / I e C i C> ,L Z r 011 l/2. /,20 0 .
APPLICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER
❑ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR
■ PROJECT INFORMATION
EXISTING USES '`` EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINIQ ERED'BUILDI NG?• OYES 0 NO ., FIRE SUPPRESSION SYSTEM PROPOSED/REQUIREDs anis 0 No
WATER SERVICE PROVIDER: ❑LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC) •
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**Ng1N RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTU RES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERTS) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACES)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINALS) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) CI ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTORS) SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any daim(induding costs,expenses,and attorneys'fees incurred in the
Investigation and defe..se cf such claim) which M !e made tly er en inciudirg the mrdpnig^ed,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
.
liication
NAME/TITLE: �C� fi�C (.may' ` �L ' ` DATE: /2--/2'• _C 3
❑PROPERTY OWNER 0 APPLICANT A CONTRACTOR
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COMMUNITY DEVELOPMENT SERVICES.. c z FIRST WAY SOUTL .2O o ;9718•FEDERAL WAY.,WA,980639718.253.661-4000•FAX:.253-661-4129
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